在随机临床试验中，前列腺生物活检前进行磁共振成像与减少生物活检次数、降低Gleason评分为6的癌症检出率以及增加Gleason评分为7或更高的癌症检出率相关。本研究旨在研究前列腺生物活检前磁共振成像是否与生物活检频率以及Gleason评分的分布在临床实践中相关。本研究采用瑞典约恩雪平地区男性的回顾性、基于人群的队列研究。研究对象为2011年11月至2020年1月间进行前列腺特异性抗原(PSA)水平测量的男性，并在2021年1月31日结束监测。已知前列腺癌的男性将被排除在外。数据分析于2022年7月至12月进行。我们从医疗记录中提取了重复的PSA测量数据、前列腺生物活检数据和MRI前列腺数据，并从国家前列腺癌登记数据库获取了癌症特征数据。计算了在引入MRI前后接受前列腺生物活检的男性比例以及Gleason评分为6或Gleason评分为7或更高癌症的风险和阴性生物活检的比例。在这项纳入23,802名男性（平均[SD]年龄为60.8[13.6]岁）进行PSA检测的队列研究中，随着MRI的使用增加，生物活检次数减少（调整后的比值比[OR]为0.84；95%置信区间[CI]为0.72-0.97），检出Gleason评分为6的癌症的几率减少（OR为0.47；95% CI为0.33-0.64），而检出Gleason评分为7或更高的癌症的几率增加（OR为1.24；95% CI为1.02-1.50）。这项研究表明，引入MRI到临床实践中与进行生物活检的男性比例减少以及检出Gleason评分为6的癌症减少但检出Gleason评分为7或更高癌症几率增加相关。这些临床数据支持在生物活检前使用前列腺MRI以避免不必要的生物活检。

In randomized clinical trials (RCTs), magnetic resonance imaging (MRI) before prostate biopsy has been associated with fewer biopsies, decreased detection of Gleason score 6 cancers, and increased detection of Gleason score 7 or higher cancers.To study whether MRI of the prostate before the decision to biopsy is associated with biopsy frequency and distribution of Gleason score in clinical practice.This is a retrospective, population-based cohort study of men in Jönköping Region, Sweden. Men with prostate-specific antigen (PSA) level measured between November 2011 and 2020 were monitored until January 31, 2021. Men with known prostate cancer were excluded. Data analysis was performed from July to December 2022.Data on repeated PSA measures, prostate biopsies, and MRI prostate were extracted from health care records, and cancer characteristics were obtained from The National Prostate Cancer Register.The proportions of men who underwent prostate biopsy and risk of Gleason score 6 or Gleason score 7 or higher cancer and negative biopsy before and after introduction of MRI were calculated.In this cohort study of 23 802 men (mean [SD] age, 60.8 [13.6] years) who underwent PSA testing, when the use of MRI increased, fewer biopsies were performed (adjusted odds ratio [OR], 0.84; 95% CI, 0.72-0.97) and the odds of detecting Gleason score 6 cancer decreased (OR, 0.47; 95% CI, 0.33-0.64), whereas the odds of detecting Gleason score 7 or higher cancer increased (OR, 1.24; 95% CI, 1.02-1.50).In this study, the introduction of MRI to clinical practice was associated with a decreased proportion of men who underwent a biopsy and decreased detection of Gleason score 6 cancer but increased detection of Gleason score 7 or higher cancer. These clinical data support the use of prostate MRI before biopsy in an effort to avoid unnecessary biopsies.